Provider Demographics
NPI:1588899413
Name:HARGREAVES, JASMIN (LPT)
Entity type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:
Last Name:HARGREAVES
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ENBORG CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2645
Mailing Address - Country:US
Mailing Address - Phone:408-885-7855
Mailing Address - Fax:408-885-7854
Practice Address - Street 1:871 ENBORG CT.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-885-7855
Practice Address - Fax:408-885-7854
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25770374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician